USE OF DIGITAL REHABILITATION PRACTICES IN LOW AND MIDDLE INCOME COUNTRIES

G. Lippolis¹, I. Lehmann²

Background: Digital rehabilitation represents a growing modality of practice in many countries, with the COVID crises having boosted its use during the confinement. If high incomes countries can count on relatively well developed regulatory mechanisms and environmental conditions that enable an appropriate use of digital practices, this is not always the case in low and middle income countries.

Purpose: In 2019, Humanity & Inclusion started the implementation of pilot projects related to the use of digital rehabilitation (Haiti, Bolivia). The objective of those pilot projects was mainly to propose remote follow up to patients that couldn’t attend regularly the rehabilitation facilities due to their health condition, the time required to reach the rehabilitation center or the costs related to travelling. With the COVID crises, the objective was for the rehabilitation centers that had to close, to ensure continuity of care for the most vulnerable and at risk users.

Methods: Before implementing this strategy, pilot studies took place to identify facilitating and limiting factors that were of significance for a possible application of digital rehabilitation in Bolivia and Haiti, specifically the use of the Physiotec (Bolivia) and Physitrack (Haiti) applications.

Results: The results of the studies showed that using rehabilitation applications for follow up purposes was doable in both countries, especially in regard to acceptation by users and professionals as well as its use with specific groups of persons. However, challenges have been observed such as limitation in internet coverage, use of smartphone, use with persons with cognitive impairment as well as organizational aspects of the sessions.  
Those challenges led to the necessity to propose alternative strategies of using digital rehabilitation in low income countries. Those alternative solutions included:
1) integrate a strong patient/caregiver education component;
2) share videos and pictures offline and with a low band option when connexion is not sufficient;
3) plan phone follow up to monitor adherence from users;
4) collaborate with primary health centers or community workers to enable the user to access mobile phone/internet connexion;
5) translate the exercises description in local language to guarantee understanding of exercises
6) add exercises that are context based and culturally acceptable…

Conclusion(s): The conclusion of those pilot projects is that the use of digital rehabilitation is considered as a solution that can overcome the lack of access to rehabilitation services for a certain number of users. Meanwhile for the most vulnerable population, living in remote rural area and not having the financial means to have access to a smartphone and qualitative connexion, it is necessary to propose alternative strategies or to limit the scope of digital rehabilitation.

Implications: For the future it is necessary to strength the inclusion of rehabilitation in the primary health care package of services, for health professional to play a role of facilitators between the rehabilitation professionals and the users when proposing digital rehabilitation. It is also important to develop a software that is more appropriate to the context and culture of low income countries (low bad, offline option, easy to translate,…).

Funding, acknowledgements: The pilote projects could be implemented trought the funding of Humanity&Inclusion, DGD- Belgian Cooperation, AFD.

Keywords: Low income countries, Digital rehabilitation

Topic: Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: University of Maastricht

Committee: University of Maastricht

Ethics number: FHML/GH_2019.020